Analysis of the Application of Cricoid Pressure: Implications for the Clinician

Beavers, Ross A.; Moos, Daniel D.; Cuddeford, James D.

doi:10.1016/j.jopan.2009.01.006

Cited by 18 publications

(41 citation statements)

References 47 publications

(78 reference statements)

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“…Seven randomized, controlled studies demonstrated that cricoid pressure can delay or prevent the placement of an advanced airway and that aspiration can occur despite application of pressure. 174 -180 Additional manikin studies [181][182][183][184][185][186][187][188][189][190][191][192][193][194] found training in the maneuver to be difficult for both expert and nonexpert rescuers. Neither expert nor nonexpert rescuers demonstrated mastery of the technique, and the applied pressure was frequently inconsistent and outside of effective limits.…”

Section: Cricoid Pressurementioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

702

495

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Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:• Immediate recognition of SCA based on assessing unresponsiveness and absence of normal breathing (ie, the victim is not breathing or only gasping) Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world. 1 SCA has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation. These actions are termed the links in the "Chain of Survival." For adults they include When these links are implemented in an effective way, survival rates can approach 50% following witnessed out-ofhospital ventricular fibrillation (VF) arrest. 2 Unfortunately survival rates in many out-of-hospital and in-hospital settings fall far short of this figure. For example, survival rates following cardiac arrest due to VF vary from approximately 5% to 50% in both out-of-hospital and in-hospital settings. 3,4 This variation in outcome underscores the opportunity for improvement in many settings.Recognition of cardiac arrest is not always straightforward, especially for laypersons. Any confusion on the part of a rescuer can result in a delay or failure to activate the emergency response system or to start CPR. Precious time is lost if bystanders are too confused to act. Therefore, these adult BLS Guidelines focus on recognition of cardiac arrest with an appropriate set of rescuer actions. Once the lay bystander recognizes that the victim is unresponsive, that bystander must immediately activate (or send someone to activate) the emergency response system. Once the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal breathing (ie, only gasping) the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR.Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. 5 Chest compressions are an especially critical component of CPR because perfusion during CPR

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Section: Cricoid Pressurementioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

702

495

View full text Add to dashboard Cite

show abstract

“…Although this study was performed on volunteers who were awake and not anesthetized patients, the results were still alarming in light of the fact that there was a high rate of error despite experienced anesthesiologists applying the pressure. In another study of hospital personnel who are expected to perform cricoid pressure on a regular basis, 50% of participants self‐reported undergoing formal training, but most had no knowledge of the anatomy or correct amount of pressure to be applied . Upon demonstration of the technique, approximately 73% of participants applied cricoid pressure incorrectly …”

Section: Challenges To Applying Cricoid Pressurementioning

confidence: 99%

“…Complicating the issue are reports of incorrect application of the maneuver fueled by a demonstrated lack of knowledge on the part of the clinician applying or assisting with the cricoid pressure procedure . Considering the lack of research to support cricoid pressure use, the lack of knowledge among those applying or assisting in the procedure, and the ethical and legal issues surrounding some organizations' suggestions not to use the maneuver, the training and education of anesthesia practitioners and nurses becomes of paramount importance.…”

mentioning

confidence: 99%

Systematic Review and Meta‐Analysis of Cricoid Pressure Training and Education Efficacy

Beckford¹,

Holly²,

Kirkley³

2018

AORN Journal

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We examined the evidence on the effectiveness of education and training on cricoid pressure (ie, Sellick maneuver) application. Cricoid pressure is used during rapid sequence induction and intubation to reduce the risk of pulmonary aspiration. We searched seven databases for studies on the education and training of health care personnel expected to apply cricoid pressure as a part of their regular clinical responsibilities. We appraised the included studies using standardized tools validated for this purpose and we performed a meta-analysis of the eight eligible studies. The success rate for intubation increased after training according to the random effect model (95% CI = 0.157 to 0.452). Fisher's method combined probability test rejected the null hypothesis for patients (P = 4.93e-6), indicating that the application of cricoid pressure significantly improved after educational interventions. Regularly scheduled training in the application of cricoid pressure could sustain health care personnel's ability to apply effective cricoid pressure.

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“…A study of American anaesthetic nurses showed that only 17.8% of them used the recommended force during cricoid pressure [13]. In a study on anaesthetists, physicians representing various specialities and medical students, Cavalache et al [14] reported that the majority of participants used cricoid pressure with inadequate force.…”

Section: Discussionmentioning

confidence: 99%

Measurement of cricoid pressure force during simulated Sellick’s manoeuvre

Andruszkiewicz

Zawadka

Kosińska

et al. 2014

Anaesthesiol Intensive Ther

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Background: Cricoid pressure is a standard anaesthetic procedure used to reduce the risk of aspiration of gastric contents during the induction of general anaesthesia. However, for several years its validity has been questioned. There still remains the question of whether we perform it correctly. The aim of the study was an evaluation of the theoretical knowledge of Sellick's manoeuvre, as well an assessment of practical skill related with it when simulated on a model of the upper airway. Methods: The study was performed on a cohort of anaesthetists and anaesthetic nurses working in various hospitals in the Warsaw area. Measurements were taken on an upper airway model placed on an electronic kitchen scale. Participants were asked to perform Sellick's manoeuvre in the way they do it in their clinical practice. The test was done twice. Both the position and pressures applied on the model were documented. Knowledge concerning current recommendations of cricoid force was noted. Results: 206 subjects participated in the study. Only 49% (n = 101) properly identified cricoid cartilage during their application of Sellick's manoeuvre. Application of the correct pressure on the model of the airway was noted in 16.5% (n = 34) during the first attempt and in 20.4% (n = 42) during the second attempt. The median force applied during simulated Sellick's manoeuvre was 36 N (IQR: 26-55) in the first attempt, and 38 in the second attempt. Conclusions: Sellick's manoeuvre was performed incorrectly in many cases. Half of the participants of our study applied the pressure in the wrong place while the majority of them used an inappropriate amount of force. Thus, the application of cricoid pressure in patients should be preceded with simulation training.

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Analysis of the Application of Cricoid Pressure: Implications for the Clinician

Cited by 18 publications

References 47 publications

Part 5: Adult Basic Life Support

Part 5: Adult Basic Life Support

Systematic Review and Meta‐Analysis of Cricoid Pressure Training and Education Efficacy

Measurement of cricoid pressure force during simulated Sellick’s manoeuvre

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